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PriorityMedicare Thrive Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare Thrive Plus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare Thrive Plus (PPO) in 2025, please refer to our full plan details page.
PriorityMedicare Thrive Plus (PPO) is a PPO plan offered by Corewell Health available for enrollment in 2025 to people living in 68 lower peninsula Michigan counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that PriorityMedicare Thrive Plus (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PriorityMedicare Thrive Plus (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For PriorityMedicare Thrive Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5600.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5600.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The PriorityMedicare Thrive Plus (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $13 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your monthly Part D premium may be reduced to $12.40.
Additional Benefits
The PriorityMedicare Thrive Plus (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay depending on the type of service and length of stay. Outpatient services, emergency services, primary care, and preventive services are also covered, with copays ranging from $0 to $350 depending on the specific service. Additional benefits include coverage for hearing, vision, and dental services with copays and coinsurance for specific services. The plan also covers home health services, and skilled nursing facility stays, with specific cost-sharing for each. Other covered services include ambulance, acupuncture, and over-the-counter items, with specific copays and limitations.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $300 copay for days 1-7, and no copay for days 8-90, with no coinsurance. For Inpatient Hospital Psychiatric, you pay a $290 copay for days 1-6, and no copay for days 7-90, with no coinsurance. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by PriorityMedicare Thrive Plus (PPO), including outpatient hospital services with a copay of $0-$350, observation services with a $120 copay, and ambulatory surgical center services with a $350 copay. Outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by PriorityMedicare Thrive Plus (PPO) with a $55 copay, and prior authorization is required. There is no coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the PriorityMedicare Thrive Plus (PPO) plan. Both ground and air ambulance services have a $240 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $120 copay, Urgently Needed Services have a $50 copay, Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $240 copay.
Primary Care See details
The PriorityMedicare Thrive Plus (PPO) plan covers primary care physician services and chiropractic services, with a $20 copay for chiropractic services. Occupational therapy and physical therapy/speech-language pathology services have a $15 copay, while physician specialist services have a copay between $0 and $40. Mental health and psychiatric services are not covered.
Preventive Services See details
Preventive Services are covered under the PriorityMedicare Thrive Plus (PPO) plan, including Medicare-covered preventive services with a doctor referral, an annual physical exam, additional preventive services, health education, in-home safety assessments, kidney disease education services, and other preventive services. The plan does not cover Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Counseling Services. The plan also offers a Fitness Benefit with a maximum plan benefit coverage amount of $285.00 every year, and Home and Bathroom Safety Devices and Modifications with a maximum plan benefit coverage amount of $50.00 every three months.
Hearing Services See details
Hearing exams and fitting/evaluation for hearing aids are covered with no copay, while prescription hearing aids are covered with a copay between $295 and $1495. Prescription hearing aids are limited to 2 per year, and routine hearing exams are limited to 1 per year.
Vision Services See details
Vision Services include eye exams with a $40 copay, along with coverage for eyewear. Eyewear has a combined maximum benefit of $100 per year for both in-network and out-of-network services.
Dental Services See details
Dental Services are covered, including oral exams with no copay, and other services like dental x-rays, cleanings, fluoride treatment, restorative services, endodontics, periodontics, and oral surgery with various limitations and cost-sharing. Orthodontic services are covered up to a maximum of $2,000 per year, and services like Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare Thrive Plus (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the PriorityMedicare Thrive Plus (PPO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetic Devices with a 0-20% coinsurance, and Medical Supplies with a 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The PriorityMedicare Thrive Plus (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay of $15, and diagnostic radiological services with a copay of at most $140. The plan also covers lab services with no copay, and therapeutic radiological services with a copay of at most $30. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by PriorityMedicare Thrive Plus (PPO), with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. There is no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
The PriorityMedicare Thrive Plus (PPO) plan covers acupuncture with a $20 copay, and over-the-counter items with a $50 benefit every three months. Other covered services include ambulance stabilization/non-transport with a $240 copay, annual wellness visits, and personalized health risk screenings with a $75 copay. However, meal benefits, dual eligible SNPs, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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